1. Multiple challenges for hospitals and healthcare in Europe Charlotte Walker Assistant Locality Manager Primary, Community and Social Care – Llanelli

2. Quality and Safety Access Workforce Cost Acceptable trade-offs Context Context = policy, population health, community characteristics, other services etc. The Determinants of World Class Health Care Longley, M. (2012) The Best Configuration of Hospital Services for Wales: A Review of the Evidence. Cardiff: Welsh Institute for Health and Social Care

3. What do we know about Malta?

5. Population of Malta 417,617 16% of the population are aged 65 years and over 359 churches 1.4 million tourists Social change - Changing family dynamics Free health care Economic Challenge

6. Society is Changing Culture is becoming more globalised Demographic Challenges Health and Social Care Expectations are Increasing

7. Religion – societal change – Churches in hospital and home GP Shopping – Registration with own GP Free Care – At point of delivery Family dynamics – changing needs Service expectations – individuals need to change

8. Scarce resources – community care team Focus on elderly institutions – everyone grows old Increasing demand for beds – strengthen bed management Limited financial commitment – forward planning Financial and political – not aligned

9. Financial planning – under-allocation of funds Ageing population – fewer taxpayers

10. Culture is becoming more globalised Significant demographic changes

11. Challenge of Societal Change Challenge of Demographic Change Challenge of Cultural Change Challenge of Economic Change

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13. Culture ReligionOne GPSilos The Maltese care Changing minds Charges

14. Community VolunteeringRespiteNight ShelterIndividual ID Incentives for older people Handy man Day Care Centres Community and mental health services Meals on wheels

15. Financial and Political EducatePlan ahead Public awareness Joint services

16.  Quality and Safety ◦ Build upon the high standard services in community ◦ Shift emphasis from beds to community ◦ Improve use of ID ◦ Public engagement  Access ◦ Densely populated country enabling easy access to services ◦ Demographic challenge – ‘Youth Brain Drain’ V Ageing Population ◦ Acknowledgement and ownership of the ageing agenda  Workforce ◦ Build upon competent & confident workforce with rich skill mix ◦ Developing advanced skills in the community ◦ Increase opportunities for younger population to limit ‘brain drain’ – training incentives  Cost ◦ Robust integrated financial planning and control required ◦ Added value through joint working (integration) and resultant increased capacity

17. M – Maltese culture A – Ageing society L – Learning environment T – Transformational A – Active ageing This is my Postcard from Malta we had a GREAT time!

18. Dankeschön Aitäh Tack Grazzi Hafna Diolch Thank you!